Tan Ping, Liu Liangren, Wei Shiyou, Tang Zhuang, Yang Lu, Wei Qiang
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Urology. 2017 Jul;105:54-61. doi: 10.1016/j.urology.2017.02.032. Epub 2017 Mar 1.
To perform a systematic review and meta-analysis to evaluate the effect of phosphodiesterase-5 (PDE5) inhibitors on sperm parameters.
A systematic literature search was performed. Mean value and its standard deviation (mean ± standard deviation) were used to perform quantitative analysis. Statistic heterogeneity scores were assessed with the standard Cochran Q test and I statistic. All statistical analyses were conducted by RevMan 5.3.
Eleven studies embraced a total of 1317 participants and 19 subgroups or trials were included. Acute administration of PDE5 inhibitors had no effect on semen volume (mean value [MD] = 0.26; 95% confidence interval [CI]: 0.00-0.48) and sperm concentration (MD = 2.04; 95%CI: -2.95 to 7.04). However, the percentage of motile spermatozoa (MD = 7.05; 95%CI: 2.59-11.51), the percentage of total progressive motility (MD = 6.23; 95%CI: 2.43-10.04), and rapid progressive motility (MD = 3.11; 95%CI: 0.23-5.99) were increased after oral PDE5 inhibitors treatment. Interestingly, these significant changes were observed only in infertile men but not in normal patients (MD = 6.89, P < .001 vs MD = 0.67, P = .71; MD = 6.64, P = .001 vs MD = 2.11, P > .05; and MD = 3.89, P = .04 vs MD = 0.92, P = .59, respectively). The percentage of morphologically normal spermatozoa also increased in infertile men (MD = 12.15; 95%CI: 5.16-19.15). Limited evidence showed the linearity, abnormal forms of spermatozoa, as well as reproductive hormones (total testosterone, free testosterone, luteinizing hormone, and follicle-stimulating hormone) did not benefit from PDE5 inhibitors treatment.
Oral PDE5 inhibitors treatment could modestly increase the sperm motility and morphology in infertile men.
进行一项系统评价和荟萃分析，以评估磷酸二酯酶5（PDE5）抑制剂对精子参数的影响。
进行系统的文献检索。采用平均值及其标准差（均值±标准差）进行定量分析。使用标准的Cochran Q检验和I统计量评估统计异质性得分。所有统计分析均通过RevMan 5.3进行。
11项研究共纳入1317名参与者，包括19个亚组或试验。急性给予PDE5抑制剂对精液量（均值[MD]=0.26；95%置信区间[CI]：0.00-0.48）和精子浓度（MD=2.04；95%CI：-2.95至7.04）无影响。然而，口服PDE5抑制剂治疗后，活动精子百分比（MD=7.05；95%CI：2.59-11.51）、总前向运动百分比（MD=6.23；95%CI：2.43-10.04）和快速前向运动百分比（MD=3.11；95%CI：0.23-5.99）均增加。有趣的是，这些显著变化仅在不育男性中观察到，而在正常患者中未观察到（分别为MD=6.89，P<.001对比MD=0.67，P=.71；MD=6.64，P=.001对比MD=2.11，P>.05；以及MD=3.89，P=.04对比MD=0.92，P=.59）。不育男性中形态正常精子的百分比也有所增加（MD=12.15；95%CI：5.16-19.15）。有限的证据表明，精子的线性、异常形态以及生殖激素（总睾酮、游离睾酮、黄体生成素和卵泡刺激素）并未从PDE5抑制剂治疗中获益。
口服PDE5抑制剂治疗可适度提高不育男性的精子活力和形态。
